Intra-vesical BCG induced granulomatous hepatitis and disseminated Koch’s: Our experience

Abstract

Bacille Calmette-Guerin (BCG) vaccine, developed by Calmette and Guerin at Institute Pasteur (Lille, France), is a live-attenuated Mycobacterium bovis strain. There are many therapeutic uses of the species have been described, Intravesical BCG has been established as an effective treatment of superficial bladder cancer. A 66-year old gentleman with newly diagnosed superficial high-grade papillary transitional cell carcinoma involving lamina propria (T1) of the bladder underwent 3 cycles of intravesical BCG. First 2 cycles were uneventful and tolerated well. After 3rd BCG cycle, patient developed granulomatous hepatitis with disseminated Koch's. BCG-induced sepsis after intra-vesical instillation for bladder cancer is a rare complication. Pathophysiology remains largely unknown, but BCG’s low virulence suggests that immunological hypersensitivity reaction probably plays a role. There have been no prospective studies to evaluate the optimal treatment for BCG infection.